Investigating the Association between Patient Gender and Rate of Provider Discussion of Health-Risk Behaviors and Mental Health Concerns in Adolescents

Abstract

Adolescence is an important time for screening, discussion, and prevention of important health issues including substance use, sexual health, and mental health. Addressing these issues early can improve adolescent health outcomes and decrease rates of related chronic health complications in adulthood. Many factors have been shown to have differing effects on the prevalence of health risk behaviors in adolescents and their rate of receiving counseling for these health topics. The purpose of this study was to determine the association between patient gender and rate of clinician discussion of health issues including substance use, sexual health, and mental health during adolescent well-child visits. Adolescents (N=440), ranging from 13-18 years old, recruited across 10 pediatric clinics in Seattle and rural areas of Washington, completed a web-based screening on areas including substance use, sexual activity, and depression and anxiety prior to their well-child visits to assess baseline activity and risk. After the visit, they completed a 1-day follow up survey to assess for discussion of the same topics by their clinicians. We utilized Stata software and Fisher’s exact test to evaluate for gender differences in the rate of activity, rate of discussion among all youth, and rate of discussion among youth who engaged in behaviors. Statistical significance was defined as α <0.05. Prevalence rates were similar for males and females with the exception of depression and/or anxiety where females reported a higher prevalence than males (p=0.003). Among all adolescents, discussion rates were similar for males and females for all topics. However, among adolescents who endorsed behaviors, sexually active males (100%, n=10/10) were more likely than females (50%, n=4/8) to receive discussion for sexual health (p=0.02). In addition, while the majority of adolescents received private time with their clinicians, fewer adolescents received discussion of specific health risk topics, highlighting the need to improve frequency and quality of private time and confidential healthcare delivery to adolescents.